PB2323: R-ESHAP VS R-ICE AS RESCUE TREATMENT IN DIFFUSE LARGE B-CELL LYMPHOMA. A SINGLE-CENTEREXPERIENCE.
Authors: Belén Pérez-Pinilla, Carolina De Bonis-Braun, Minerva Montalvo Saavedra, Marta Diaz-Lopez, Paula Reyes González-Casanova, María José Rodríguez Salazar, Patricia Machado-Machado, Jose Maria Raya, Miguel Teodoro Hernandez Garcia, Sunil Lakhwani Lakhwani
Journal: HemaSphere (2023)

Topic: 19. Aggressive Non-Hodgkin lymphoma - Clinical Background: Diffuse large B-cell lymphoma (DLBCL) is the paradigm of aggressive lymphomas with potentially curable behavior. First-line treatment achieves a complete response (CR) rate around 60%. Patients who don´t achieve CR and patients with relapses after CR will need second line treatment. In those patients who are candidates for autologous hematopoietic stem cell transplantation (HSCT), platinum-based regimens are preferred. The two most commonly schemes used in Spain are R-ICE and R-ESHAP, and no differences in efficacy and security have been reported between the two schemes. Aims: Analyze and compare the efficacy and safety of patients with relapsed or refractory (R/R) DLBCL treated R-ICE vs R-ESHAP regimens at a single center. Methods: A retrospective observational study was conducted in which patients with R/R DLBCL diagnosed and treated in our center and received R-ESHAP or R-ICE as rescue treatment between January 2010 and January 2023, were included. The medical records of these patients were reviewed, and several clinical and biological variables were recorded. Staging and responses were considered according to the revised recommendations of the International Working Group. Overall survival (OS) and progression-free survival (PFS) were estimated from the time of starting R-ICE or R-ESHAP. Results: A total of 19 patients diagnosed with R/R DLBCL were included. All of them were candidates for autologous HSCT. Mean age was 58 years old (range 38 – 77) and there were 10/19 men (52,6%). All the patients received a first line of treatment with R-CHOP except two of them who were treated with BRCAP and one with R-CVP. At diagnosis, 58% of patients were stage IV and 68% had B symptoms. Only 5 patients received R-ESHAP (26,3%) as rescue therapy and 14 patients received R-ICE (73,7%). The reason for the initiation of platinum-based therapy was disease recurrence after achieving CR with first line in 10/19 patients (52,6%) and insufficient response to first line treatment in 6/19 (31,6%) or progression to first line treatment in the remainder (3/19, 15,8%). Complete response rate was 2/5 (40%) with R-ESHAP and 4/13 (30,8%) with R-ICE but the difference was not statistically significant. Overall response rate was 4/5 (80%) with R-ESHAP and 9/13 (69,2%) with R-ICE and the difference was also not significant. Median PFS was 13,7 months for R-ESHAP and 6,1 months for R-ICE, but difference with log-rank test was also not significant (p=0,368). Kaplan-Meier curves for OS run far apart from each other (Figure 1) with median OS not reached for R-ESHAP and 15,5 months for R-ICE, but difference was not statistically significant with log-rank test probably due to the small sample size (p=0,167) In terms of toxicity, we compared transfusion requirements, duration of severe neutropenia, anaemia and thrombocytopenia with transfusion requirements and non-hematologic toxicities in the two groups, but we found no significant differences except for the number of days of severe neutropenia per cycle, where a median of 4 days for R-ESHAP and 8 days for R-ICE, with a statistically significant difference (p=0,026). Summary/Conclusion: Despite a very small sample size, we found significant differences in toxicity, with R-ESHAP being less toxic in duration of sever neutropenia than R-ICE. Although we found no significant differences in efficacy, the way in which the OS Kaplan-Meier curves are separated suggests that with a larger sample size there could be. Therefore, larger population studies are needed to reach more accurate conclusions.Keywords: Toxicity, Diffuse large B cell lymphoma, Autologous bone marrow transplant